Healthcare Provider Details

I. General information

NPI: 1134872005
Provider Name (Legal Business Name): CATHERINES HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 36TH ST SW
WYOMING MI
49509-3587
US

IV. Provider business mailing address

1211 LAFAYETTE AVE NE
GRAND RAPIDS MI
49505-5092
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SARA BROOKS
Title or Position: DIRECTOR OF OPERATIONS
Credential: MPA
Phone: 616-336-8800